Our day started with this young man complaining of pneumonia-like complaints - pleuritic chest pain, fever, seen by his PCP and given abx.  He felt that after 2 days his antibiotics weren't working, so he just stopped taking them.  Now he's concerned about the shortness of breath.  There is no concept of antibiotic resistance among the patients here.  

 This brother wasn't leaving his little sister's side.  She was hit by a car on her way to school today.  Luckily she only suffered a concussion, but due to persistent vomiting - we watched her overnight in the hospital.

 She got bumped pretty good on her face - but fortunately, no fractures.

 This precious little boy belongs to the mom lying next to him.  She and her husband got into an argument about his multiple girlfriends, and questionable extra wife.  During the middle of this argument - after he left the house, she decided to swallow bleach.  She admitted to me later that she only swallowed a drop of the bleach, but that she had doused herself in kerosene yesterday due to all of these problems at home.  She didn't follow through with setting herself on fire because of this little guy being home at the time.  She eventually eloped from the A/E.  A little different here- no room 20 to lock these patients in if there is concern for being a flight risk.

 This was a difficult day.  The next lady was one of those cases you just can't shake.  She was wheeled in to the A/E in a wheelchair with her head hanging all the way back and looked as if her forehead was separated from the rest of her face.  She wouldn't talk, only cried.  Eventually she told me that her husband - while drunk - beat her in front of his friends with a cement block.  She said she was able to escape - ran to her neighbors house, and was told to keep running because they didn't want any trouble.  She made it close enough to the police station and was brought in.  She was rightfully scared to death.  We kept her in the hospital - and I checked on her twice a day because she told me she wanted to leave her husband and was sad no one would come visit her.  This is one of those cases where I didn't know if she'd be leaving the hospital alive, much the less, the A/E.  But she didn't have any fractures or bleeds - was fully alert and oriented with no focal deficits.  Incredible.  The pictures don't even do it justice.  So after several days of going and checking on her in the wards - and asking multiple times if women's services had been notified (it hadn't), I stopped by yesterday afternoon to find her husband at her bedside.  She looked petrified - more in the regards that she didn't want me to react and was scared I would, which might make it worse for her.  I was furious and defeated from the lack of concern for this patient.  After a long conversation with my mom (surprise, surprise) I resolved to readdressing the entire issue with her the next morning, hoping beyond all hopes that she hadn't changed her mind.  I just didn't want to cause any more trouble for her than she was already facing with him after putting him in jail before his parents placed bail.  Impressively, she hadn't and had formed a plan to go back to her family.  I asked her to write to me and let me know that she was safe.

 Unfortunately, these pictures really minimize the impressiveness of the wounds.

 On a happier note - I have found temporary substitutes for Max and Jax!  These are the program director's dogs.  Mine would be squeaky toys to these guys!

 Altered mental status patient - known hepatitis B pt with obvious cirrhosis

 The only words he would answer questions with were the four-letter kind - funny what is instinctive to people!

 The set up for my paracentesis - betadine had to be borrowed from the surgical rooms as there was none in the A/E.

 

 Hooking him up to a drain

 Yes, it's a foley bag - works perfectly!

 The next morning the patient was pretty much back to baseline - smiling, conversant.  Lactulose is impressive - except, in order to give it at the hospital, the family has to take the prescription and run it to the local pharmacy and bring it back to dispense.

 This little girl started with an infected tooth - gradually worsening of the past several days - notably worse since 4 am.

 Her amount of trismus is impressive.  Eventually we got general surgery on board to drain her in the operating room - ENT declined the case.

 Look familiar to Hermann??  Two conversations going at once!